On February 3rd, the Centers for Disease Control and Prevention (CDC) published the 2014 recommended immunization schedule for children and adults. It's not so different from last year’s schedule, but serves as a good reminder of what vaccines have meant to our lives.
Between 1924 and today, vaccines have spared 103 million children in the United States from disease and death. A few examples of their power:
- Polio is gone from our shores—the last cases of naturally occurring paralytic polio were in 1979, when an outbreak occurred among the Amish in several Midwestern states. We’re now talking about the possibility of worldwide polio elimination within the next decade.
- The measles vaccine was introduced in the late 1960’s and within five years 95 percent of cases were prevented.
- Haemophilus influenzae type B epiglottitis, an infection involving the vocal cord area, was one of the most dreaded diseases seen by ER docs when I was in training in the 1970’s. Children would come in blue and unresponsive because they were unable to obtain sufficient air, and their lives could be saved only by an emergency tracheostomy. A vaccine was introduced against this bacterium in 1985; today’s ER docs have never seen a case.
- We’ve had an effective vaccine against tetanus and diptheria since the 1920’s. I’ve been an infectious diseases consultant for nearly 40 years and have seen one case of tetanus and only know what diphtheria looks like because of textbook pictures.
The list of vaccine successes goes on and on. But there has been a resurgence of some diseases in recent years because some parents postpone or skip their children’s immunizations. In 2012, the United States experienced the worst whooping cough outbreak since 1959, in large part because of so many unimmunized children. Measles, all but eliminated from this country, has made a comeback. In 2011, cases nearly quadrupled from the annual average over the preceding decade. Last spring, an intentionally unvaccinated adolescent returned to New York City from London with measles, leading to the largest U.S. outbreak in nearly 20 years. More than 98 percent of measles in the United States were brought here by unvaccinated individuals and spread to those who were unvaccinated. "This isn't the failure of a vaccine," said Thomas Frieden, M.D., director of CDC. "This is the failure to vaccinate.”
Adults not only fail to vaccinate their children, but themselves as well. Influenza vaccination is recommended for everyone over six months of age each year. To date, this has been a more severe influenza season than usual (In California, there have already been more than 200 deaths, nearly twice as many as in all of the previous year). Although the vaccine is effective against the types of influenza viruses that are circulating, it’s not as potent as we would like; it appears to protect around 60 percent of people from becoming ill.
But, if everyone got it, there would be a lot fewer sick people and a lot fewer people to spread the disease to others. Pregnant women are at increased risk for severe influenza-related illness and hospitalization. That’s why it is especially important for this group to be vaccinated. Last year, only 50 percent of pregnant women had the flu vaccine. And a disturbing statistic about our hospitals: Only about 65 percent of all health care workers in United States get vaccinated against influenza.
How would you like to be sick in the hospital and cared for by someone who is at increased risk of getting and spreading influenza?
Other adult vaccines are targeted to specific populations based on age, health conditions, occupation, travel and other indications. On February 7, the CDC published data on vaccine coverage in adults. Only about half of those over 64 have received a tetanus/diphtheria shot in the last decade (protection lasts about 10 years; that’s why we need boosters). One in five adults has received the shingles vaccine (shingles is a miserable disease and occurs more frequently as we age). The very effective vaccine to prevent cervical cancer (the HPV vaccine) is underutilized. Only about one-third of women who would benefit from this vaccine have received more than one dose of the vaccine—three doses are recommended. The pneumococcal vaccine helps prevent the most common bacterial cause of pneumonia and its complications. It is recommended for all adults over 64, but only about 60 percent of candidates have taken advantage of it.
Why, with vaccines being one of the greatest tools available for preventing death and misery, do so many shun them? Even if we don’t care about protecting ourselves, why do many parents deprive their children of protection? Are we so self-centered that we’re blind to the idea that prevention of disease in one individual means that the disease will not be spread to others, a concept known as herd immunity?
There’s no one answer to these questions. Charlatans and fearmongers have always been with us but can now use the internet to reach a much wider audience. For example, the notion that vaccines cause autism is still perpetuated over the internet, even though more than a dozen excellent studies have debunked this idea. Science illiteracy and anti-science movements—even in some public schools—also deserve some of the blame.
And public health professionals and doctors could be much more proactive in exposing vaccine myths and promoting their benefits. Ironically, probably the biggest reason people don’t get vaccinated is that they rarely see the diseases that vaccines now prevent. Success has bred complacency.
I remember standing with my parents in a very long line in front of my local school in the 1950’s awaiting the sugar cubes containing the polio vaccine. Polio affected nearly every family and I doubt there were many parents who denied their child this vaccine. We surely don’t want to go back to those days to prove to ourselves the value of vaccines.